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ESTIMATING THE IMPACT OF HIV PREP REGIMENS CONTAINING LONG-ACTING INJECTABLE CABOTEGRAVIR OR DAILY ORAL TENOFOVIR DISOPROXIL FUMARATE/EMTRICITABINE AMONG MEN WHO HAVE SEX WITH MEN IN THE UNITED STATES: A MATHEMATICAL MODELLING STUDY FOR HPTN 083
HIV
Injectable PrEP
Long-acting PrEP
MSM
Mathematical modelling
Men who have sex with men
Pre-exposure prophylaxis
Author
Affilliation
MRC Centre for Global Infectious Disease Analysis. School of Public Health. Imperial College London. London, United Kingdom / HIV Prevention Trials Network Modelling Centre. Imperial College London. London, United Kingdom.
MRC Centre for Global Infectious Disease Analysis. School of Public Health. Imperial College London. London, United Kingdom / HIV Prevention Trials Network Modelling Centre. Imperial College London. London, United Kingdom.
Vaccine and Infectious Disease Division. Fred Hutchinson Cancer Center. Seattle, WA, USA.
Vaccine and Infectious Disease Division. Fred Hutchinson Cancer Center. Seattle, WA, USA.
Centers for Disease Control and Prevention. Atlanta, GA, USA.
Division of Vector-Borne Diseases. Centers for Disease Control and Prevention. San Juan, Puerto Rico.
Centers for Disease Control and Prevention. Atlanta, GA, USA.
Bridge HIV, Population Health Division. San Francisco Department of Public Health. San Francisco, CA, USA / University of California San Francisco. Department of Medicine. San Francisco, CA, USA.
Vaccine and Infectious Disease Division. Fred Hutchinson Cancer Center. Seattle, WA, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brazil.
University of California Los Angeles. Center for Clinical AIDS Research and Education. Los Angeles, CA, USA / Division of Infectious Diseases. David Geffen School of Medicine at UCLA. Los Angeles, CA, USA.
accine and Infectious Disease Division. Fred Hutchinson Cancer Center. Seattle, WA, USA.
MRC Centre for Global Infectious Disease Analysis. School of Public Health. Imperial College London. London, United Kingdom / HIV Prevention Trials Network Modelling Centre. Imperial College London. London, United Kingdom.
Vaccine and Infectious Disease Division. Fred Hutchinson Cancer Center. Seattle, WA, USA.
Vaccine and Infectious Disease Division. Fred Hutchinson Cancer Center. Seattle, WA, USA.
Centers for Disease Control and Prevention. Atlanta, GA, USA.
Division of Vector-Borne Diseases. Centers for Disease Control and Prevention. San Juan, Puerto Rico.
Centers for Disease Control and Prevention. Atlanta, GA, USA.
Bridge HIV, Population Health Division. San Francisco Department of Public Health. San Francisco, CA, USA / University of California San Francisco. Department of Medicine. San Francisco, CA, USA.
Vaccine and Infectious Disease Division. Fred Hutchinson Cancer Center. Seattle, WA, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brazil.
University of California Los Angeles. Center for Clinical AIDS Research and Education. Los Angeles, CA, USA / Division of Infectious Diseases. David Geffen School of Medicine at UCLA. Los Angeles, CA, USA.
accine and Infectious Disease Division. Fred Hutchinson Cancer Center. Seattle, WA, USA.
Abstract
Background: The HPTN 083 trial demonstrated superiority of HIV pre-exposure prophylaxis (PrEP) containing long-acting injectable cabotegravir (CAB) to daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) among men who have sex with men (MSM). We compared the potential population-level impact of TDF/FTC and CAB among MSM in Atlanta, Georgia. Methods: An MSM HIV transmission model was calibrated to Atlanta-specific data on HIV prevalence and PrEP usage (percentage of uninfected MSM on PrEP), assuming only PrEP-indicated MSM used PrEP. CAB effectiveness (efficacy × adherence) of 91% was estimated using data from HPTN 083 and previous TDF/FTC trials. We estimated HIV infections averted over 5/10 years if TDF/FTC use were maintained, or if all TDF/FTC users switched to CAB in January 2022 (vs. no PrEP or continued TDF/FTC use). CAB scenarios with 10%/20% more users were also considered. Progress towards Ending the HIV Epidemic (EHE) goals (75%/90% fewer HIV infections in 2025/2030 vs. 2017) was estimated. Findings: We predicted TDF/FTC at current usage (∼28%) would avert 36.3% of new HIV infections (95% credible interval 25.6-48.7%) among all Atlanta MSM over 2022-2026 vs. no PrEP. Switching to CAB with similar usage may prevent 44.6% (33.2-56.6%) infections vs. no PrEP and 11.9% (5.2-20.2%) infections vs. continued TDF/FTC. Increasing CAB usage 20% could increase the incremental impact over TDF/FTC to 30.0% over 2022-2026, getting ∼60% towards reaching EHE goals (47%/54% fewer infections in 2025/2030). Reaching the 2030 EHE goal would require 93% CAB usage. Interpretation: If CAB effectiveness were like HPTN 083, CAB could prevent more infections than TDF/FTC at similar usage. Increased CAB usage could contribute substantially towards reaching EHE goals, but the usage required to meet EHE goals is unrealistic.
Keywords
CabotegravirHIV
Injectable PrEP
Long-acting PrEP
MSM
Mathematical modelling
Men who have sex with men
Pre-exposure prophylaxis
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